Allergy + Immunology

Question 1

What types of medications give serum sickness?

Answer 1

anti-rejection meds
antitoxins
antivenoms

Question 2

What medications can give serum sickness-like reactions?

Answer 2

penicillins
sulfonamides
cephalosporins
streptomycin
hydantoins
griseofulvin
bupropion
fluoxetine
thiouracil
infliximab/rituximab

Question 3

When does serum-sickness present?

Answer 3

7-14 days after initial exposure (can be less if re-exposure)

Question 4

What is the pathophysiology of serum sickness?

Answer 4

1. protein exposure
2. antigen excess
3. antibody response - antibody-antigen complexes
4. deposition of immune complexes in tissues causing local inflammation and complement activation
5. increased vascular permeability, histamine release, bronchospasm

Question 5

What are the symptoms of serum sickness?

Answer 5

fever
malaise
rash
arthralgias/arthritis
lymphadenopathy
angioedema
nephritis (hematuria, edema, oliguria)

less common:
abdo pain
HSM
carditis
wheezing
neuro deficits

Question 6

What are the symptoms of serum sickness-like reactions?

Answer 6

fever
pruritis
urticarial rash
arthralgia

Question 7

without treatment duration of serum sickness?

Answer 7

1-2 weeks

Question 8

Labs for serum-sickness or sickness-like

Answer 8

ESR
CBC - high or low WBC
C3, C4 - low
BUN, Cr
ANA, RF
Hepatic enzymes
Hep b screen
Heterophile antibody
IMmune complex assay

Urinalysis
ECG
Stool heme test

Question 9

Treatment of serum sickness or sickness-like reaction

Answer 9

antihistamines
NSAIDs
corticosteroids - severe arthritis despite nsaids (prednisone 1-2mg/kg/day)

Question 10

Indications for hospitalization of HSP

Answer 10

uncontrolled pain
significant GI bleeding
surgical abdomen
AKI

Question 11

What medication should be use for HSP induced hypertension?

Answer 11

Calcium-channel blockers

Question 12

What medication can be used to reduce proteinuria in HSP?

Answer 12

ACE-inhibitors

Question 13

When are steroids indicated in HSP treatment?

Answer 13

severe GI symptoms

Question 14

When does serum sickness usually present?

Answer 14

7-14 days after exposure to foreign serum protein

Question 15

What are the usual symptoms of serum sickness?

Answer 15

fever
malaise
rash
arthralgias/arthritis
lymphadenopathy
angioedema
nephritis

Question 16

Will C3, C4, CH50 be high or low in serum sickness?

Answer 16

LOW

Question 17

How is serum sickness treated?

Answer 17

antihistamines (pruritis, angioedema), NSAIDs (arthralgia, arthritis), corticosteroids (severe arthritis despite NSAIDs)

Question 18

Medications that can cause serum sickness

Answer 18

Penicillins
Trimethoprim sulfate
Minocycline
Meropenem

Bupropion
Carbamazepine
Phenytoin
Sulfonamides
Barbiturates

Question 19

Criteria for atypical/incomplete kawasaki

Answer 19

Fever for at least five days + 2 of clinical features OR
Fever 7+ days without other explanation

+ CRP > 30 and/or ESR > 40 +
3 of
- Anemia
- PLT > 450
- Albumin < 30
- Elevated ALT
- WBC >15
- Sterile pyuria

Question 20

What are the characteristics of Polyarteritis nodosa?

Answer 20

focal, pan-mural, necrotizing inflammation of small and medium-sized muscular arteries

Question 21

What infections is polyarteritis nodosa associated with?

Answer 21

Strep
hepatitis b/c

Question 22

What are the effects of polyarteritis nodosa on the following systems?

Renal
GI
CNS
Resp
Cardiac

Answer 22

Renal - proteinuria, abnormal urinary sediment, hypertension
GI - abdo pain secondary to gut vasculitis
CNS - seizures, hemiparesis
Resp - diffuse infiltrates, pulmonary hemorrhage, hemthorax
Cardiac - pericarditis, cardiomegaly, myocardial infarction, ECG changes

Question 23

What is the management of polyarteritis nodosa?

Answer 23

corticosteroids
(prednisone 2mg/kg/day)

Question 24

What emergent conditions can be the result of polyarteritis nodosa?

Answer 24

renal insufficiency
hypertension
CHF, MI, Dysrhythmia
GI vasculitis - bowel infarction, perforation, cholecystitis
Seizures, cranial nerve palsies

• creates aneurysms that can burst and cause hemorrhagic shock in any organ also